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Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System
(2022)
Barry Ting Sheen Kweh
;
Jin Wee Tee
;
Sander Muijs
;
F. Cumhur Oner
;
Klaus John Schnake
<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p < 0.001) and A4 (p < 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p < 0.001) and A4 (p < 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p < 0.001) and A4 (p < 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p < 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.</jats:p> </jats:sec>
17Scopus© Citations 3
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Accuracy and reliability of the AO Spine subaxial cervical spine classification system grading subaxial cervical facet injury morphology
(2021)
Juan P. Cabrera
;
Ratko Yurac
;
Alfredo Guiroy
;
Andrei F. Joaquim
;
Charles A. Carazzo
13Scopus© Citations 7
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Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction?
(2021)
Fernanda Santis‐Moya
;
Carlos Ignacio Calvo
;
Tania Rojas
;
Arturo Dell'Oro
;
Paulina Baquedano
Scopus© Citations 14 1
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Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study
(2021)
Gaston Camino-Willhuber
;
Alfredo Guiroy
;
Mariano Servidio
;
Nelson Astur
;
Fernando Nin-Vilaró
<jats:sec><jats:title>Study Design:</jats:title><jats:p> Multicentric retrospective study, Level of evidence III. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay. </jats:p></jats:sec>
2Scopus© Citations 16
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Evaluación funcional y de factores limitantes del tratamiento de los trastornos de la marcha en la parálisis cerebral infantil: desarrollo del sistema de clasificación de niveles de deambulación funcional
(2020)
Ignacio Martínez Caballero
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Gonzalo Chorbadjian Alonso
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Rosa Mª Egea Gámez
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Álvaro Pérez-Somarriba Moreno
;
Carlos Humberto Prato de Lima
Scopus© Citations 4 12
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Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility
(2021)
C. Prakash Gyawali
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Frank Zerbib
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Shobna Bhatia
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CISTERNAS, DANIEL
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Enrique Coss‐Adame
8 1Scopus© Citations 48
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High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals
(2022)
Arvind Rengarajan
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Benjamin D. Rogers
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Zhiqin Wong
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Salvatore Tolone
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Daniel Sifrim
30 1Scopus© Citations 33
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Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0
<sup>©</sup>
(2020)
Rena Yadlapati
;
Peter J. Kahrilas
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Mark R. Fox
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Albert J. Bredenoord
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C. Prakash Gyawali
1Scopus© Citations 828 1
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Reliability Evaluation of the New AO Spine-DGOU Classification for Osteoporotic Thoracolumbar Fractures
(2022)
Guisela Quinteros
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Juan P. Cabrera
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Julio Urrutia
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Charles A. Carazzo
;
Alfredo Guiroy
Scopus© Citations 13 1
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Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation
(2022)
Juan P. Cabrera
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Alfredo Guiroy
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Charles A. Carazzo
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YURAC BARRIENTOS, RATKO JOVAN
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Marcelo Valacco
1Scopus© Citations 9

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